Anyway we saw a 55 year old Chinese woman with a past medical history of uterine cancer at age 35 (huh?!) presenting with generalized abdominal pain.

On physical examination:
- jaundices (scleral icterus)
- tender hepatomegaly (unable to assess size as the ED doctors were busy assessing her and that she's reluctant to be examined due to complaints of tenderness on palpation)
- no shifting dullness

FAST (focussed assessment with sonography in trauma) showed no fluid in morrison's pouch and splenorenal angle.

This got us puzzled. So what are the causes of tender and painful hepatomegaly?
- We HAV Cardiac failure
1. Weil's disease (Leptospira. Biphasic symptoms: non specific 1st phase, hepatosplenomegaly with nephritis in the 2nd phase. Transmission: urine and even semen of infected animals like pigs and rats)
2. Hepatoma (HCC whcih could have ruptured)
3. Actinomycosis, amoebiasis, abscess
4. viral hepatitis
5. cardiac failure